Management hemianopia

Hemianopia, partial loss of the field of vision, is a condition usually the result of a stroke although other neurological disorders such as tumours can be responsible.

From the Greek; hemi – half, an – without, opia – sight.

Damage to an individual’s brain in the area responsible for interpreting visual input is the most common cause;

Paris with full visual fields.png

Normal field of vision

Paris with hemianopia.png

Hemianopia

The thing about hemianopia is that often the person experiencing the condition is unaware. Imagine the entire right side of your world stops existing; your brain, just as with your physiological blind-spot very quickly recovers and compensates.

People who have experienced strokes will not uncommonly eat a meal and leave half the plate, not because they can’t see it (which they can’t), but because for that person there is no right or left side of the plate.

leftfood.png

We call this situation neglect. I guess that is apposite.

I first encountered this in Oliver Sack’s case histories. I can remember the story of a man waking-up in bed to find a strange object beside him; inert, disconnected – it was his own leg. (This might have been Alien Hand Syndrome, that is for another day.)

(For this reason, medical students, if you ever talk with someone who has experienced a major stroke, always make sure you are in their field of vision and not presenting as a disembodied voice.)

Once understanding this concept, I thought I would stretch the idea to include the way that certain branches of management operate.

It is all too easy for me to pick hospital management, but, what the heck.

Imagine you are running an organisation – it is perhaps doing OK, books balanced, care, treatment, production all at levels you anticipated at the start of the year; the plan is on plan. Beautiful; you can even go on holiday and chill-out.

If back home things go wrong; I don’t know, perhaps, the money that was thought to be in the bank is actually a deficit or, the equipment you have been using to undertake operations is in some way faulty, you have two options.

One, investigate, get as much information as possible, conclude and communicate.

The other, is to do the above, but pretend all is OK; assume that everything will be well – this, the ostrich strategy you might call it is more common within organisations than at first might seem logical; we have the 2007/8 Global Financial Crisis as a case study.

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Much analysis has happened since that time and is ongoing; in healthcare, our equivalent is the Mid Staffordshire Hospitals – is disaster the wrong word*? People running so fast on a treadmill that if they get off the uncertainty is more frightening than their high-speed collapse.

Good, clever, insightful people become blinded to what is obvious; hemianopia. It is there, it is clear to everyone else, but in the case of the afflicted it doesn’t exist.

Other words are lacuna, scotoma, absence.

Through careful therapy, a person can recover from hemianopia – utilising mirror-neurones, physical and psychological treatments, that which was lost can return.

How do we support those caught in management hemianopia to recover? Is there a treatment or a means of defence?

Be open, honest, vulnerable and candid.

Don’t hide behind false prophets or slogans.

Acknowledge that the world is never entirely knowable; accept dissonance. Ask for help.

And, if the humility isn’t there? If the situation is extreme and the walls falling-down?

What would you do?

head in the sand.jpg

*Officially it was a ‘scandal’

3 comments

  1. I guess for the safety of patients and colleagues, one would have to go to a higher level still. Whistle blowers should be welcomed but I don’t know whether that is true in practice.
    Some may suggest joining management yourself —- personally I would rather have the dedicated doctor right there at the bedside.

    Liked by 1 person

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